Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 19525DC | CA |
NPI | 1982610804 |
---|---|
Provider Name | Dr. Brian Macdonald |
First Address | Berkeley, CA 94703-2439 |
Second Address | Berkeley, CA 94703-2439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |